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Women's Health

When It's Time Scalpel-free birth control ends the childbearing years. By Dr. Lisa KaramardianPublished: August, 2003

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In November, the government approved the first non-incision method of sterilizing women. This tiny device, called Essure, is transforming the way many women are ending their childbearing years. It has been used routinely in Australia, Europe, Canada and Singapore. Here is information about this high-tech, noninvasive replacement for tubal ligation ("having your tubes tied") or vasectomy. Essure is a small, spring-like coil made of polyester fibers and nickel-titanium alloy, the same materials used to make artificial heart valves. Two micro-inserts are placed into the vagina (without any cuts) and threaded through the cervix and into the uterus where each coil is placed into the fallopian tubes via a hysteroscope. When a coil is released, it expands and anchors itself in place and begins to irritate the lining of the fallopian tube. The resulting inflammation causes scar tissue to form around the coil, thus blocking off the entrance to the tube. Once the tubes are blocked, sperm is prevented from reaching and fertilizing the egg, thereby preventing pregnancy. After having the Essure procedure, a woman must use another form of birth control for at least three months until the inflammatory reaction is complete. At this time, a study called a hysterosalpingogram is done to ensure that the tubes are completely obstructed. This radiologic test involves injecting dye into the uterus and watching to see if it spills out of the tubes. For a small percentage of women, it takes between three and six months after the procedure for the tubes to become completely occluded. Conceptus, the San Carlos corporation that is marketing this technology in permanent birth control, is training physicians nationwide to be able to place the device. Dr. Jonathon Wheeler, a private practice gynecologist in Newport Beach, has been trained by the company and is one of the few physicians locally who has begun to perform these high-tech sterilizations. An advantage is that the Essure procedure does not require any incisions, therefore there is no cutting, crushing or burning of tissue, and consequently no scars. Most women tolerate the procedure very well and it can be performed under local anesthesia with or without intravenous sedation. This is a great option for women who are not good candidates for general anesthesia, or for women who are poor surgical candidates because of obesity, severe heart problems, or a history of prior pelvic surgeries. Recovery from the procedure is so rapid that women are typically discharged from the medical facility 45 minutes after the procedure and can resume normal activities by the next day. Patient satisfaction is high and the procedure is very effective. Also, the Essure micro-inserts do not contain or release any hormones. A few words of caution: As with all sterilization procedures, Essure is only meant to be used by women who are certain they no longer want to have children. Studies have shown that women under age 30 are more likely to regret their decision to be sterilized. If you are under age 30, consider carefully this irreversible and permanent procedure. I always counsel all patients to avoid making any important decisions during times of stress, such as divorce or miscarriage. For some 11 million American women, tubal sterilization is currently the birth control method of choice. A vast majority of these procedures are performed by laparoscopy, thus involving the risks of general anesthesia, possible injury to bowel or bladder, postoperative pain and a multi-day recovery. Essure offers an attractive option for women. Ask your doctor. Dr. Lisa M. Karamardian is a board-certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. A frequent speaker in the community, she also serves as medical advisor for Contemporary Nutrition. For comment in our Letters department: IEFmag@aol.com or inlandempirefamily.com. By FAX: 949.757.1996.

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